1. Copending Patent Applications
In copending U.S. patent application Ser. No. 822,096, now abandoned, entitled SURGICAL STAPLER filed Aug. 5, 1977, and assigned to the present assignee, a hemostatic clip applicator for the strangulation of tubular members in a rapid and automatic manner is disclosed. Also, in copening U.S. patent application Ser. No. 822,095, now U.S. Pat. No. 4,188,953, entitled HEMOSTATIC CLIP filed Aug. 5, 1977, and assigned to the present assignee, hemostatic clips adapted for utilization in the present invention and similar devices is disclosed. The former copending patent application entitled SURGICAL STAPLER is directed, in part, to a device having a main body and a disposable clip cartridge which may be attached and removed from the main body. Disposed within the clip cartridge are a plurality of hemostatic clips, while disposed within the main body is a clip feed means which moves clips, which have been fed into the main body, to clip deforming jaws where the clips are deformed about a blood vessel or the like.
While the applicator noted in the preceding paragraph provides a novel method for automatically closing blood vessels and other fluid ducts, refinements can be made so that the entire device, including the main body, can be made more inexpensively. Such an inexpensive device may then be sterilized by the manufacturer, packaged to maintain the sterilization, and then entirely disposed of following a single use. In particular, the device of the copending application required careful machining of a slot through the main body so that the feed means would be accurately guided therethrough. Furthermore, that device required the use of a separate lost motion link to provide the necessary sequential actuation. It is toward the refinement of the device disclosed in the copending U.S. patent application noted above that the present invention is directed, and more specifically, toward a device which can be inexpensively stamped instead of machined and which requires fewer parts.
2. Field of the Invention
The invention relates to the field of devices useful in the application of hemostatic clips, and more specifically, to devices for the application of hemostatic clips used in the strangulation of blood vessels and other fluid ducts.
3. Prior Art
In a typical surgery procedure, a great many veins, arteries, and other blood vessels must be severed and closed. This is often a difficult and time consuming procedure since many vessels are located in obscure areas where there is little room in which to work. Thus, it is apparent that a device which would reduce the time required for closure of blood vessels would be of great benefit to both the surgeon and the patient. However, in the modern surgery environment, such a device should be simply and effectively constructed so that its cost will allow for disposal of the device following usage by the surgeon, thereby eliminating the necessity of costly re-sterilization.
One prior art attempt to provide a device which can more rapidly close a blood vessel is disclosed by Wood, U.S. Pat. No. 3,326,216. The Wood device consists of a hemostat-like instrument which has finger loop portions coupled to jaw portions. The jaw portions are adapted to hold a hemostatic clip therebetween so that the clip may be closed about a vessel by bringing the finger loops together. Wood also discloses a separate cartridge which holds a plurality of clips. When the Wood device is to be used, the jaw portions are placed about one clip contained in the cartridge, and the clip is removed from the cartridge by the engagement of the clip by the jaw portions. When the clip has been used, a new clip may be placed in the device by returning to the clip cartridge and inserting a new clip. Two problems are apparent with the Wood device. First, the hemostatic clips are not automatically fed into the jaws of the device, but must be individually placed there. This procedure is time consuming and cumbersome. In addition, the Wood device is capable of expanding its jaws wider than the width of a clip contained therein. Thus, a clip may be accidentally droped from the device causing a great deal of inconvenience and delay.
A second prior art attempt to provide more rapid yet effective strangulation of blood vessels and the like is described by Miles, U.S. Pat. No. 3,082,426. Miles discloses a surgical stapling device which consists of finger loops coupled to a pair of arms which terminate in jaw portions, the jaw portions being adapted to grasp and hold a tubular member. The device also has a magazine for holding a plurality of clips along the length of one arm, and manually operable clip ejector means for placing a clip about the tubular member which is to be closed. In operation, the tubular member is first grasped and held by the jaw portions of the Miles device. The surgeon then places his index finger on a button attached to the clip ejector. By urging the button forward, the clip ejector places a clip about the tubular member. Then, the clip may be deformed about the blood vessel by bringing the pair of finger loops together. An obvious disadvantage of the Miles device is that it is cumbersome, in that the surgeon must manually move a clip between the jaws of the device while holding the device steady so as not to loose the grasp of the tubular member. Also, as the clips are used from the cartridge, the button moves farther foward so that it becomes more and more difficult to reach. Furthermore, this procedure is time consuming in that each individual clip must be manually fed between the jaws of the stapling device. Finally, the construction of the Miles device, particularly in the jaw portions, provides poor visability to the surgeon since the thickness of the device obscures the vessels which are to be closed.
Another prior art attempt to provide rapid application of hemostatic clips is disclosed by DeCarlo, U.S. Pat. No. 3,740,944. DeCarlo discloses a gun-like device for suturing and severing blood vessels in a three stage procedure. First, jaws of the device are closed about the blood vessel by the actuation of the gun-like trigger mechanism. Second, a pair of pushers extend through the device and come forward to crimp a pair of clips, brought from an internal magazine, about the vessel in two spaced locations. Third, a blade comes forward from the device upon further actuation of the gun-like handles and severes the blood vessel between the two clip locations.
The internal clip magazine of the DeCarlo device uses a pair of leaf spring assembles to index a plurality of pairs of hemostatic clips. The clips are stored in a pair of index guide rails where they are moved forward in unison by opposing leaf spring assemblies. One leaf spring assembly is attached to the moveable main body portion while the opposing leaf spring assembly is affixed to one guide rail. When the gun-like handles are actuated, the leaf spring assembly attached to the main body moves forward and contacts portions of the clips contained within the magazine. Further movement of the main body portion moves individual clips along the index guide rail and ultimately ejects a pair of clips. When a pair of clips has been ejected, the main body portion begins to return to its original static position. During this rearward movement of the main body portion, there is a transference of a pair of clips from the index guide rails to the ejection guide rails. This transference occurs when each leaf spring assembly and its corresponding ramp portions guide a clip from one index guide rail to the ejection guide rail where it is available for loading into the front portion of the instrument.
One problem with the DeCarlo device is that, due to the three stage operation, the device is necessarily bulky. This is a major disadvantage in that many surgical procedures require severence and closure of blood vessels in very limited areas so that a bulky instrument may not be able to reach the required vessel. The bulkiness of the device also creates a further disadvantage in that it produces a lack of visibility for the surgeon. Thus, the very vessel that is to be severed and closed may be obscured since the surgeon may not be able to see around the device. A further disadvantage stems from the fact that the DeCarlo device does not adapt to the application of a single clip, but only applies a pair of clips to the vessel to be closed. In a great many surgical procedures, only the application of one clip is desired while the application of two clips would only complicate the severance procedure.
Accordingly, it is a general object of the present invention to provide an improved hemostatic clip applicator device for the strangulation of blood vessels and the like.
It is another object of the present invention to provide an improved hemostatic clip applicator device which automatically feeds clips to its forward portion and then provides automatic deformation of the clips about blood vessels.
It is yet another object of the present invention to provide an improved hemostatic clip applicator device which provides high visibility to the user.
It is yet another object of the present invention to provide an improved hemostatic clip applicator device which is simply constructed and relatively inexpensive so that the entire device is disposable after a single use.
It is a still further object of the present invention to provide an improved hemostatic clip applicator device which is incapable of accidentally dropping clips from the device.